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NUR 336 Exam 1 Questions With Complete Solutions
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NUR 336 Exam 1 Questions With Complete Solutions
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NUR 336 Exam 1 Questions With Complete SolutionsA client on an inpatient psychiatric unit tells the nurse, "I should
have died because I am totally worthless." In order to encourage
the client to continue talking about feelings, which should be the
nurse's initial response?
a. "How would your family feel if you died?"
b. "You feel worthless now, but that can change with time."
c. "You've been feeling sad and alone for some time now?"
d. "It is great that you have come in for help." Correct Answers
C (This nursing statement is an example of the therapeutic
communication technique of reflection. When reflection is used,
questions and feelings are referred back to the client so that they
may be recognized and accepted.)
A mother rescues two of her four children from a house fire. In
the emergency department, she cries, "I should have gone back
in to get them. I should have died, not them." What is the nurse's
best response?
a. "The smoke was too thick. You couldn't have gone back in."
b. "You're feeling guilty because you weren't able to save your
children."
c. "Focus on the fact that you could have lost all four of your
children."
d. "It's best if you try not to think about what happened. Try to
move on." Correct Answers B (The best response by the nurse
is, "You're experiencing feelings of guilt because you weren't
able to save your children." This response utilizes the
therapeutic communication technique of reflection which
,identifies a client's emotional response and reflects these
feelings back to the client so that they may be recognized and
accepted.)
A nurse assists a patient with a Foley catheter to ambulate down
the hall. The nurse holds the catheter bag above the level of the
patient's bladder. What link in the chain of infection is the nurse
breaking by doing so?
a. Portal of exit.
b. Portal of entry.
c. Reservoir.
d. Host susceptibility. Correct Answers B (By not allowing the
urine from the bedside drainage bag to re-enter the bladder, the
nurse is breaking the chain of infection at the portal of entry.
Emptying the bedside drainage bag may be an example of
controlling the reservoir. Host susceptibility has to do with
issues such as age, nutritional status, medical treatments,
immunizations, etc.)
A nurse calls the health care provider for their patient and
suggests that an EKG be ordered for the patient. Which part of
SBAR does this represent?
a. Situation
b. Background
c. Assessment
d. Recommendation Correct Answers D (Recommendation
involves suggesting/requesting that the HCP order certain tests,
a change in the patient's treatment, a higher level of care is
needed (Ex. referral to a specialist) and asking the HCP is they
,have any questions for you or if they need any other
information.)
A nurse inspects the clients mouth using a penlight and tongue
place. The nurse notes the ability of the uvula with phonation
and inspects the patient's buccal mucosa, teeth, gums, tongue,
and floor of mouth. The nurse tests the patient's sense of taste.
The nurse asks that patient to open their mouth and say 'AHH'.
Which of the following two cranial nerves is the nurse testing
for?
a. IX and X
b. VIII and IX
c. VII and X
d. VII and IX Correct Answers A (Cranial nerves IX and X are
the Glossopharyngeal and Vagus nerves. They are tested for by
inspecting the patient's mouth, assessing the sense of taste,
observe the patient's ability to swallow, and the 'AHHH' test.)
A nurse is assessing a client's musculoskeletal system and
palpates the patient's knees and hears a grating sound that is
produced by friction between bone and cartilage. What is the
name of this abnormal finding?
a. Bogginess
b. Crepitus
c. Nodularity
d. Bruits Correct Answers B
, A nurse is assessing a client's vital signs and asks if they are
having any pain. The patient replies yes, which question relating
to pain should the nurse ask next?
a. What makes your pain better or worse?
b. How do you usually behave when you are in pain?
c. What is the rate of your pain on a scale from 0 to 10?
d. Where do you feel the pain? Correct Answers C
A nurse is assessing a patient's neck. Which of the following is
considered an expected finding?
A. Jugular vein distention
B. Midline trachea
C. Carotid artery prominence
D. Thyroid enlargement Correct Answers B
A nurse tells a doctor a patient has diabetes. Which part of the
SBAR model is this statement?
a. Situation
b. Background
c. Assessment
d. Recommendation Correct Answers B (Parts of a patient's
background include what they were admitted for, their
background history, labs and tests pertinent to the reason for the
call, their current therapy, and their current vital signs.)
A patient has been transferred to a wheelchair with a transfer
belt. What is one action the nurse would take to position the
patient safely in the chair?
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